바로가기  >

Abstract
Objective: We evaluated the efficacy and safety of postoperative radiotherapy (PORT) for differentiated thyroid cancer (DTC) with high risk features.

Materials and methods: This retrospective study analyzed 187 patients treated for DTC from 1985 to 2019. DTC referred to nonanaplastic thyroid cancer originating from follicular cells. PORT was defined as the administration of external beam radiation to the thyroid and regional lymph nodes following surgery for initially diagnosed DTC. The patients were included in the analysis if they received PORT or exhibited any of the following features: (a) pT4 or pN1b according to the 8th American Joint Committee on Cancer, (b) poorly differentiated thyroid cancer (PDTC), or (c) unfavourable variants such as anaplastic foci and etc. After 1:1 propensity matching, a total of 108 patients were analyzed according to PORT receipt. The median follow-up duration of the matched group was 10.4 years.

Results: After matching, most of the variables became balanced, but the PORT group still had more PDTC and DTC with anaplastic foci. Radioactive iodine (RAI) was less frequently administered in the PORT group. PORT yielded a significantly higher 5-year locoregional recurrence free survival (LRFS) than the No PORT group (5-year LRFS 86.1% vs. 72.7%, p = 0.022), but the 10-year cancer specific survival (CSS) was similar between them (97.8% vs. 85.9%, p = 0.122). The multivariable analysis indicated that PORT was a favourable prognostic factor (Hazard ratio 0.3, 95% Confidence interval 0.1-0.8, p = 0.02) for LRFS, but not for CSS. Among 133 patients without PORT for initial disease, 39 of them received salvage surgery followed by salvage PORT. No severe toxicity after PORT was reported.

Conclusion: PORT reduced locoregional recurrence in DTC patients without severe toxicity. PORT can be an effective and safe treatment to improve locoregional control in DTC with high risk features. However, further study is warranted to identify those who can benefit from PORT.

Affiliations

Hyejo Ryu 1, Hong-Gyun Wu 1 2 3, Kyu Eun Lee 4, Eun-Jae Chung 5, Soon-Hyun Ahn 5, Young Joo Park 6, Hoon Sung Choi 7
1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
2Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
3Medical Research Center, Institute of Radiation Medicine, Seoul National University, Seoul, Korea.
4Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
5Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea.
6Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
7Department of Internal Medicine, Chungang University Gwangmyeong Hospital, Gyeong-gi, Korea.